Leptomeningeal Metastases

This information explains leptomeningeal metastases and how it is treated.

Cancer cells from some types of cancer can spread to the membranes that cover the brain and spinal cord. These membranes are called the meninges. They can also spread to the cerebrospinal fluid (CSF). CSF bathes these membranes and the spinal cord.

When cancer cells are found in either the meninges or CSF, it is called leptomeningeal metastases (lep-toe-men-IN-geel me-TASS-ta-seez), or LM. It can trigger a wide variety of symptoms.

Symptoms

You may have 1 or more of these symptoms. Having 1 symptom does not mean you will necessarily develop others.

Diagnosis

Your doctor may perform several diagnostic tests to see if you have LM. If your doctor suspects that you have LM, you may have magnetic resonance imaging (MRI) of your brain or spine. An MRIscan takes detailed pictures of a specific part of your body without using x-rays. It can be used to diagnose LM.

If the MRI does not show LM, your doctor may want to do a lumbar puncture, sometimes called an LP or a spinal tap. For an LP, the skin on your lower back will be numbed. Then, a needle will be inserted into your spinal canal so that a sample of your CSF can be removed. Your doctor or nurse does this test so that your CSF can be examined for cancer cells. If cancer cells are found, a diagnosis of LM is confirmed.

You may need to have more than one LP because it can be hard to find cancer cells in the CSF. An LP also may be done to measure the pressure of your spinal fluid. If it is high, it can also cause symptoms, even if the MRI shows LM.

Treatment

The goal of treatment for LM is to relieve your symptoms and to try to kill the cancer cells that are in your CSF. Treatments include radiationtherapy, chemotherapy, or both. The type of treatment your doctor thinks is best will depend on the type of cancer you have, your symptoms, and your test results. Your doctor and nurse will discuss your treatment plan in depth with you and your family.

Radiation therapy

You may receive radiation therapy to your head or to areas on your spinal cord where clusters of cancer cells are seen. You may need radiation to both your head and spinal cord. Sometimes, it is given to 1 area first and to another area at a later time.

Radiation therapy can be given to you while you are in the hospital, but they are usually given when you are an outpatient. Your doctor will make this decision with you.

Chemotherapy

Chemotherapy for LM is usually given straight into the CSF. It may be given to you during an LP. More commonly, it is given through an Ommaya reservoir. This is a dome-shaped device that is placed under your scalp during a surgery. It is done under general anesthesia and takes about 1 hour. You will have some discomfort at the incision when the anesthesia wears off. Be sure to ask for pain medication, if you need it.

The Ommaya reservoir has a small tube that connects it to the areas of the brain where CSF is formed. Chemotherapy given through the Ommaya reservoir can get into your CSF directly. This means you do not need to have an LP. Chemotherapy given this way has very few side effects because only a small dose is needed to treat the cancer cells in the CSF. There may be times when you will need to have an LP, even though you have an Ommaya reservoir. Your chemotherapy will be given to you as an outpatient.

You may also receive chemotherapy by vein or by mouth. This is to control both your primary cancer and the LM.

Caring for Yourself During Your Treatment

There are many ways to help you manage the symptoms of LM. It is important to describe new problems or any change or improvement in your symptoms to your doctor or nurse. This helps them decide whether your treatment is working. It also lets them know if some adjustments are needed in your treatment plan.

A diagnosis of LM may cause anxiety. Your doctor, nurse, or social worker will discuss any concerns you may have about LM and your primary cancer. Please share your questions with them.

Last updated: January 1, 2011

anesthesia (A-nes-THEE-zhuh)

A loss of feeling or awareness caused by drugs or other substances. Anesthesia keeps patients from feeling pain during surgery or other procedures. Local anesthesia is a loss of feeling in one small area of the body. Regional anesthesia is a loss of feeling in a part of the body, such as an arm or leg. General anesthesia is a loss of feeling and a complete loss of awareness that feels like a very deep sleep.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

anxiety (ang-ZY-eh-tee)

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

ARMS

A soft tissue tumor that is most common in older children and teenagers. It begins in embryonic muscle cells (cells that develop into muscles in the body). It can occur at many places in the body, but usually occurs in the trunk, arms, or legs. Also called alveolar rhabdomyosarcoma.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

bladder (BLA-der)

The organ that stores urine.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

bowel (BOW-ul)

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel. Also called intestine.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

cancer (KAN-ser)

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord. Also called malignancy.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

chemotherapy (KEE-moh-THAYR-uh-pee)

Treatment with drugs that kill cancer cells.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

CSF

The fluid that flows in and around the hollow spaces of the brain and spinal cord, and between two of the meninges (the thin layers of tissue that cover and protect the brain and spinal cord). CSF is made by tissue called the choroid plexus in the ventricles (hollow spaces) in the brain. Also called cerebrospinal fluid.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

CSF

Cerebrospinal fluid. The fluid flowing around the brain and spinal cord. CSF is produced in the ventricles of the brain.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

device (dee-VISE)

An object that has a specific use. In medicine, wheelchairs, pumps, and artificial limbs are examples of devices.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

diagnosis (DY-ug-NOH-sis)

The process of identifying a disease, such as cancer, from its signs and symptoms.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

dose (dose)

The amount of medicine taken, or radiation given, at one time.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

fluid (FLOO-id)

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

imaging (IH-muh-jing)

In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as x-rays (high-energy radiation), ultrasound (high-energy sound waves), and radio waves.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

incision (in-SIH-zhun)

A cut made in the body to perform surgery.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

leptomeningeal (LEP-toh-meh-NIN-jee-ul)

Having to do with the two innermost meninges (thin layers of tissue that cover and protect the brain and spinal cord).

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

lumbar puncture (LUM-bar PUNK-cher)

A procedure in which a thin needle called a spinal needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give drugs. Also called spinal tap.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

mean (meen)

A statistics term. The average value in a set of measurements. The mean is the sum of a set of numbers divided by how many numbers are in the set.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

medication (MEH-dih-KAY-shun)

A legal drug that is used to prevent, treat, or relieve symptoms of a disease or abnormal condition.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

MRI

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called magnetic resonance imaging, NMRI, and nuclear magnetic resonance imaging.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

nurse (nurs)

A health professional trained to care for people who are ill or disabled.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

Ommaya reservoir (oh-MY-uh REH-zer-vwahr)

A device surgically placed under the scalp and used to deliver anticancer drugs to the fluid surrounding the brain and spinal cord.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

outpatient (OWT-pay-shunt)

A patient who visits a health care facility for diagnosis or treatment without spending the night. Sometimes called a day patient.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

radiation (RAY-dee-AY-shun)

Energy released in the form of particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

radiation therapy (RAY-dee-AY-shun THAYR-uh-pee)

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

scan (skan)

A picture of structures inside the body. Scans often used in diagnosing, staging, and monitoring disease include liver scans, bone scans, and computed tomography (CT) or computerized axial tomography (CAT) scans and magnetic resonance imaging (MRI) scans. In liver scanning and bone scanning, radioactive substances that are injected into the bloodstream collect in these organs. A scanner that detects the radiation is used to create pictures. In CT scanning, an x-ray machine linked to a computer is used to produce detailed pictures of organs inside the body. MRI scans use a large magnet connected to a computer to create pictures of areas inside the body.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

social worker (SOH-shul WUR-ker)

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

spinal canal (SPY-nul kuh-NAL)

The narrow, fluid-filled space in the spinal column (the bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone). The spinal cord runs through the spinal canal.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

spinal cord (SPY-nul kord)

A column of nerve tissue that runs from the base of the skull down the back. It is surrounded by three protective membranes, and is enclosed within the vertebrae (back bones). The spinal cord and the brain make up the central nervous system, and spinal cord nerves carry most messages between the brain and the rest of the body.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

spinal tap (SPY-nul ...)

A procedure in which a thin needle called a spinal needle is put into the lower part of the spinal column to collect cerebrospinal fluid or to give drugs. Also called lumbar puncture.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

spine (spine)

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spine encloses the spinal cord and the fluid surrounding the spinal cord. Also called backbone, spinal column, and vertebral column.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

surgery (SER-juh-ree)

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

symptom (SIMP-tum)

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

therapy (THAYR-uh-pee)

Treatment.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

vein (vayn)

A blood vessel that carries blood to the heart from tissues and organs in the body.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)

will (wil)

A legal document in which a person states what is to be done with his or her property after death, who is to carry out the terms of the will, and who is to care for any minor children.

Source: The National Cancer Institute's Dictionary of Cancer Terms(http://www.cancer.gov/dictionary)